Implementation of back at work after surgery (BAAS): A feasibility study of an integrated pathway for improved return to work after knee arthroplasty

Abstract

Purpose: Optimizing return to work after knee arthroplasty is becoming more important because of the growing incidence of KA among workers and poor return to work outcomes. The purpose of this study is to investigate the feasibility of Back At work After Surgery (BAAS): an integrated clinical pathway for return to work after knee arthroplasty.Method: Working patients who received unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA) between January 2021 and November 2021, younger than 65 years and motivated to return to work were eligible to participate. Feasibility was investigated on ve domains: reach, dose delivered, dose received, delity and patients' attitudes. These outcomes were obtained by a patientreported questionnaire and an interview with the occupational case manager and medical case manager.Results: Of the eligible 29 patients, eleven were willing to participate (response rate 38%; due to travel distance to and from the hospital). The dose delivered was between 91 and 100%, except information given about return to work from the orthopedic surgeon which was 18%. The dose received was 100%.For delity, case managers reported nine shortcomings for which ve solutions were mentioned. In terms of patients' attitude, all patients were satis ed and one patient mentioned an improvement.Conclusions: In terms of reach, participation was low: only 29%. The BAAS clinical pathway seems feasible based on dose delivered, dose received, delity and patient attitudes. The next step is to assess the effectiveness of the BAAS clinical pathway for return to work.

Protocol for a multicenter study on (cost)effectiveness of the Back At work After Surgery (BAAS): a clinical pathway for knee arthroplasty

“…The strengths of this protocol are that the BAAS clinical pathway was already proven feasible (13). This way, not only did we learn that BAAS was feasible to implement, but we also learned important lessons to optimize the BAAS clinical pathway before evaluating its effectiveness, costs, and bene ts.…”

“…The following BAAS work-directed care is offered to the patient, which was proven feasible (Appendix I) (13). The orthopedic surgeon provides information before surgery about returning to work after surgery in terms of expected time to RTW and the known prognostic factors like female gender, a rmative patientreported work-relatedness of knee symptoms, high physical work demands, high Body Mass Index (BMI), and prolonged preoperative sick absence from work (39,40).…”

“…The next step is to analyze the effectiveness and costs of the BAAS clinical pathway to RTW.To the best of our knowledge, this is the rst study on work-directed and patient-centered care after KA systematically involving health care experts other than an orthopedic surgeon and a physical therapist. Timely involvement of occupational care experts seems to be an important evidence-based prerequisite to ensure that the BAAS clinical pathway can be more effective on RTW after KA than usual care (6,13,15). However, since the true effectiveness and costs or bene ts of the BAAS clinical pathway are still unknown, analysis on effectiveness and economic evaluation of BAAS is expedient.…”

Does Consulting an Occupational Medicine Specialist Decrease Time to Return to Work Among Total Knee Arthroplasty Patients? A 12-Month Prospective Multicenter Cohort Study

“…Moreover, in line with the hierarchy of risk management it is more ethical to start with adjusting the work to the patient’s needs, especially if the work is knee-straining. Recent studies have shown that interventions supporting RTW in arthroplasty patients based on knowledge for safe recovery, also regarding work-related activities, and sustainable RTW are being developed [ 11 , 29 , 30 ]. Managing too high patient expectations has also been suggested in TKA patients for better patient-reported outcome as well as RTW [ 12 , 31 , 32 ].…”